Application for TEEN SPOTLIGHT: A Summer Theatre Workshop for BIPOC Teen Artists
The Station Theatre invites teens who identify as BIPOC (Black, Indigenous and People of Color) to join this new FREE theatre training program! No experience necessary. The workshop consists of 9 sessions, July 12-30: Monday, Wednesday and Friday afternoons from 2–5pm. A final showcase will be performed and videotaped on Saturday, July 31 at 2pm at the Station Theatre, 223 N. Broadway Ave. in Urbana. All COVID safety protocols will be followed, and most activities will take place outside the theater building. Space is limited! Apply by June 20. Questions? Email: stationtheatre.cu@gmail.com.
Section 1:
To be completed by teen participant and parent/guardian
Student Name
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First Name
Last Name
Date of BIrth
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Month
-
Day
Year
Date
Student Email Address
example@example.com
Best phone number
*
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Area Code
Phone Number
Can this number receive texts?
Yes
No
Other
Student Phone (if different)
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Area Code
Phone Number
Can this number receive texts?
Yes
No
Other
Your School and Grade in Fall 2021
*
Gender Pronouns
She/Her/Hers
He/Him/His
They/Them/Theirs
Other
Regarding race/ethnicity, how do you self-identify?
Please list any previous experience with arts-related activities: acting, poetry/spoken word, singing, dancing, writing, music, visual art/design (at school, church, theater, online, etc.):
Do you have a favorite Hobby?
Book/Movie/TV show?
Song/Musician
Play/Musical:
Have you ever attended a live theatre production? If so, what stands out in your mind about the play? (Include the title, if you know it.)
Why do you want to participate in TEEN SPOTLIGHT this July?
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How did you hear about Teen Spotlight? (if from a friend or teacher, please include their name)
The Station Theatre is located in downtown Urbana (on Broadway Ave. at the train tracks). What form of transportation would you use for arrival at 2pm and departure at 5pm on MWF afternoons? (Select all that apply)
Walk/Bike
I will drive.
Parent will drive
Bus
I will need some help figuring out transportation.
Other
I agree to follow necessary COVID-19 safety measures.
*
YES
Other
COMMITMENT: If I'm accepted to this program I will commit to attend all 9 workshops (July 12-30, MWF, 2-5pm), plus the July 31 afternoon performance, unless I am ill or I have an emergency situation.
*
yes
I may have some conflicts and will list those below.
Back
Next
Possible conflicts:
If we need to hold any sessions via Zoom, do you have a computer and adequate internet access to participate virtually?
Section 2:
To be completed by parent/guardian over age 18
Primary Parent/Guardian Email Address
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Does your child have any medical restrictions or concerns related to their participation in this program? Are there any accommodations or accessibility issues you wish to share with the staff? Anything written below will have absolutely no impact on participation, and will only be consulted to enable the participant to comfortably and safely participate.
GENERAL RELEASE & PUBLICITY RELEASE The Celebration Company at the Station Theatre (together with officers, directors and instructors “The Station”): I give permission for my child to participate in TEEN SPOTLIGHT, taking place in and around The Station from July 12–31, 2021. This General Release Form & Publicity Release covers the entirety of my child's participation in TEEN SPOTLIGHT, including travel to and from The Station. I acknowledge and understand that being associated with this workshop requires a moderate level of physical activity, and that certain risks are inherent in participating in these activities. These risks include, but are not limited to injury, illness (including, especially COVID-19), death, property damage, and property loss or theft. These risks, known and unknown, may arise out of accidents or circumstances, including, but not limited to, the negligent acts or omissions of my child or others (including The Station). Therefore, I HEREBY RELEASE, WAIVE, DISCHARGE AND HOLD HARMLESS THE STATION, FROM ANY AND ALL CLAIMS, LIABILITY, JUDGMENTS, COSTS AND EXPENSES FOR ANY PERSONAL INJURY OR ILLNESS, ILLNESS, VIRUS, DISEASE, DEATH, PROPERTY DAMAGE, LOSS AND/OR THEFT, ARISING OUT OF MY CHILD'S PARTICIPATION WITH TEEN SPOTLIGHT. I ALSO AGREE TO DEFEND, INDEMNIFY AND HOLD HARMLESS THE STATION FROM AND AGAINST ANY LIABILITY STEMMING FROM MY CHILD'S OWN ACTS OR OMISSIONS RELATED TO TEEN SPOTLIGHT. Further, I hereby grant The Station, and those acting under its authority, the right and license to film and/or take photographs of my child in connection with TEEN SPOTLIGHT and to use their name, image, and likeness in all forms and media. I understand that I will not own any rights to the TEEN SPOLTIGHT Showcase and I waive any opportunity and/or right to inspect or approve the Showcase or the use of my name, image, and likeness in the manner stated above. By clicking below, I certify that I have read and fully understand the above.
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I am 18 or older, and I agree to the terms above.
Other
Primary Parent/Guardian
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Submit
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